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Background: GISTs are gastrointestinal mesenchymal tumours that express the type III receptor tyrosine kinase KIT. The KIT proto-oncogene encodes the receptor KIT. Most GISTs have gain-of-function mutations in the KIT or PDGFRA gene. The tyrosine kinase is therefore continuously activated leading to ligand-independent dimerization. Imatinib mesylate (Glivec®) is considered to be the first-line palliative treatment. The activated form of the KIT receptor tyrosine kinase is inhibited by imatinib. The aim of the study was to compare the survival of patients treated with either adjuvant or down-staging imatinib with historic controls treated with radical surgery (R0) only.

Methods: A historic control group was chosen from a population-based series from western Sweden (population 1.6 million) that matched the adjuvant (n=23) and down-staging (n=7) groups respectively. Mutation analysis was performed in all cases with bidirectional direct sequencing. The recurrence-free survival was calculated.

Results: There was only one recurrence (4 %) in the adjuvant group, and no recurrences in the down-staging study group, compared to 32/48 patients (67 %) in the control group. Tumour size decreased in diameter from 20 cm to 11 cm with down-staging treatment.

Conclusion: Adjuvant imatinib improves recurrence-free survival in R0 resected patients. Down-staging treatment with imatinib is recommended for patients with large tumours or metastases. The importance of mutation analysis was established.

Tick-borne encephalitis virus is the cause of much morbidity and sometimes a fatal infection. A vaccine based on formaldehyde inactivated virus is currently the only available way of preventing disease. This vaccine gives a high rate of seroconversion but there are reports of vaccination breakthrough, even in people who have demonstrated a neutralizing antibody response. The T cell response to inactivated TBE vaccine is largely unknown, but could be of importance for the effect of the vaccine. This study characterizes aspects of the T cell response by investigating the expression of two transcription factors, T-bet and GATA-3 with RT-PCR. T-bet is expressed in CD4+ T cells of the Th1 type, while GATA-3 is expressed in CD4+ T cells of the Th2 type. Our data show that vaccination with inactivated TBE vaccine leads to increase in expression of the T-bet gene when cells of vaccinated subjects are cultured with TBE virus. In contrast, the expression of GATA-3 remains unaffected by vaccination. Thus, this study suggests that the inactivated TBE vaccine leads to a Th1-like immune response in humans.

We here report a case of a young man who presented to his general practitioner with diarrhea. Inflammatory bowel disease was suspected and a colonoscopy showed aphthous lesions suggestive of Crohns' disease but biopsies revealed eggs of Enterobius vermicularis. When treated for this parasite, his symptoms were alleviated and a followup colonoscopy revealed a normal colon and distal ileum. Enterobius vermicularis is the most common parasite worldwide and has been attributed with many different presentations and pathologies. It is therefore necessary to maintain vigilance, even in high-income countries, in order to diagnose patients with one of the many atypical presentations of pinworms.

Objectives: In Nepal, the change of the abortion law in 2002 extended the staff duties at family planning clinics to include performing induced abortions. This study investigated the experiences, opinions and attitudes of the staff about their work at safe abortion service centres in the Kathmandu Valley and identified areas in which the health care staff stated the need for improvement.

Study design: Fifteen qualitative semi-structured interviews were conducted with doctors and nurses working with induced abortion at one hospital and five clinics in the Kathmandu Valley. The interviews were transcribed verbatim and analysed using the constant comparative method.

Results: The core category ‘Proud, not yet satisfied’ comprised a strong perception of providing an important service that is beneficial for women’s health and a feeling of pride in providing quality service. Four related categories were identified: ‘Beneficial legal framework’, ‘A will to reach out to all women’, ‘Frustration about misuse’ and ‘Dilemma of sex-selective abortion’. The respondents emphasised that improvements are necessary to (1) ensure that all women have access to safe abortion services; (2) prevent abortions from being used instead of contraceptives; (3) stop illegal medical abortions; and (4) deal with the dilemma of sex-selective abortions.

Conclusions: Respondents were proud of and had psitive experiences from their work. They stated they have the opportunity to secure women’s rights and health; however, changes are needed to bring the quality of abortion care to a satisfactory level.

Aim and Objective: The aim of the study was to investigate whether there is any association between cerebral palsy (CP) and celiac disease(CD) in children. Patients and Methods: Ninety children between 18 months and 18 years of age (median 9 years) with CP were included. Antibodies (IgA and IgG) against gliadin (AGA), endomysium (EMA), and tissue transglutaminase (tTG) were measured. Children with elevated levels of these antibodies were offered a small-bowel biopsy. Results: Thirty-nine children showed an elevated level of 1 or more of the tested antibodies (43%). None had raised EMA antibodies. Presence of tetraplegia or dyskinesia was associated with increased antibody levels (P=0.045), as was a more severe functional type of CP (P=0.008). Children with elevated antibodies had a lower body weight (P=0.049), height (P=0.041), and body mass index (BMI) (P=0.014). Small-bowel biopsies were performed in 27 out of 39 children; 1 had CD and 2 had intraepithelial lymphocytosis. Conclusions: A large number of children with CP had elevated AGA and/or anti-tTG. Because these elevations were associated with lower weight, height, and BMI, it seemed of interest to speculate on how these findings correlated to CP and CD. However, we found no correlation between CP and CD.

BACKGROUND: Exercise is known to decongest the nasal mucosa which results in increased nasal patency. In a recent study it was suggested that smoking might influence the effect of exercise on the nasal mucosa. This implies that smoking may cause neurological damage to the normal nasal physiology, which has not previously been shown. The aim of this study was to investigate whether there was a difference in nasal mucosal reaction to exercise between smokers and non-smokers.

METHODOLOGY: Forty-two smokers and non-smokers underwent acoustic rhinometry to register nasal geometry before and after cycling on an ergometer cycle. A structured interview was used for questions about smoking habits and airway symptoms.

RESULTS: Both smokers and non-smokers had a significant increase in MCA (minimal cross-section area) and total nasal volume after exercise. There was no statistical significant difference between smokers and non-smokers.

CONCLUSIONS: Smoking does not seem to affect the normal physiological decongestion of the nasal mucosa after exercise.

Background: A recently published study by us shows interesting incidence numbers of myocardial infarction (MI) in two close cities. One of the cities has the highest incidence of MI in Sweden. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. MI among women of working age is a relatively rare event. It can be an indicator of the current health situation in a city. The purpose of this study was to analyze lay perceptions and believes regarding the disease among affected women in their social context. Knowledge about this can give us a better understanding about how they think, act and choose in life.

Methods: We focused on younger women under 65 years of age affected by MI. Qualitative interviews was made with 12 women in the defined region.

Results: The majority of the women mentioned inner stress as a cause for, and specific life events adjacent to the MI. All women in the study point out conventional risk factors (smoking, obesity, lack of exercise, diet, and heredity) as an explanation for their MI. Finally, most of these women had high demands on themselves, put other people's needs above their own and some testified about very traumatic life experiences.

Conclusions: Knowledge about young women affected by MI and their lay perceptions is an important prerequisite for preventive measures for this special group.

Background: The leading cause of death and loss of disability-adjusted life years globally are cardiovascular diseases. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. The aim of this study was to estimate the occurrence of common cardiovascular diseases and cardiovascular mortality in defined populations in two geographical close but socially different cities, a white-collar and a blue-collar twin city - “The Twincities”.

Methods: We focused on the total population in these two neighbouring and equally sized cities with a population of around 135 000 inhabitants respectively, representing two close but different social environments in the same Swedish county. Data about morbidity for the two cities was derived from an administrative health care register based on medical records assigned by the physicians at both hospitals and primary care and calculated as cumulative incidence rates. Mortality for ischemic heart diseases is based on official Swedish national statistics.

Results: The cumulative incidence of cardiovascular diagnoses for younger as well as elderly men and women revealed significant differences between these two cities. The relative risks for both sexes were highest for all cardiovascular diagnosis studied and cardiovascular mortality in the population of the blue-collar twin city.

Conclusions: There are major differences in cardiovascular morbidity and mortality between the studied twin cities representing two close but different social environments. Since these differences seem to be profound and stable over time preventive measures is warranted in the blue-collar city.